What Is a Revision Rhinoplasty?
Revision rhinoplasty is a broad term for surgery on a nose that has already been operated on. The patient has had a previous rhinoplasty, is unhappy with the functional and/or aesthetic result, and seeks improvement through a second procedure. More precisely, “revision” rhinoplasty refers to a second operation performed by the same surgeon who did the first, while “secondary” rhinoplasty refers to a second operation performed by a different surgeon.
Almost every plastic surgeon would agree that revision rhinoplasty is the most difficult operation in the field, for several reasons: scar tissue from the prior surgery, the absence of septal cartilage, altered anatomy, a higher risk of infection, and slower, less predictable healing.
Once the nasal bones and cartilage have been exposed and manipulated, scar tissue forms, and the degree of scarring varies from patient to patient. That scar tissue makes re-exposing the underlying structures more challenging and time-consuming. When septal cartilage is absent, or normal anatomy has been removed, the structural support of the nose must be rebuilt: septal cartilage is typically the first choice, and when it is no longer available, rib cartilage is usually the next.
The skin and soft-tissue envelope can also be damaged, sometimes requiring soft-tissue grafting to improve healing and reduce the risk of complications. Overall, recovery after revision rhinoplasty is longer and less predictable than after a primary rhinoplasty, the risk of infection is higher, and swelling can be more pronounced and prolonged.
Dr. Namin’s Philosophy
The decision to undergo a revision rhinoplasty is stressful and emotional. The nose is the centerpiece of the face, and the patient is coping with a result that did not meet their expectations, often after already investing significant time, money, and hope. It is, understandably, a very difficult decision.
There are two reasons to consider revision rhinoplasty: persistent nasal breathing problems and cosmetic imperfection. The surgeon must first understand what is bothering the patient, both functionally and aesthetically, and then identify the underlying anatomic source of that problem. In revision cases, this is not always possible until the operation itself, so the surgeon must be prepared for anything encountered and have several plans in place. Above all, Dr. Namin must believe he can make a meaningful change, one that will satisfy the patient’s goals.
Before proceeding with an operation of this kind, it is essential that Dr. Namin and the patient agree on the goals, and that the patient clearly understands both the potential complications and the recovery to expect.